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General NPI Number Information
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NPI Number | 1871590745
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Entity Type | Organization
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Legal Business Name | OGDENSBURG MEDICAL GROUP P.C.
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1231 CONGRESS ST
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City | OGDENSBURG
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State | NY
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Zip | 13669-3268
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Country | US
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Telephone | 315-393-2295
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Fax | 315-393-9604
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Provider Business Mailing Address
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Address Line | PO BOX 308 1231 CONGRESS ST
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City | OGDENSBURG
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State | NY
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Zip | 13669
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Country | US
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Telephone | 315-393-2295
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Fax | 315-393-9604
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDERICO A LOINAZ
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Credential | M.D.
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Telephone | 315-393-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 108852
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License Number State | NY
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